1/3. Haemorrhagic shock and encephalopathy syndrome: report of two cases with special reference to hypoglycaemia.Haemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disorder affecting infants. So far no cases have been reported in switzerland. It is characterised by the abrupt onset of hyperpyrexia, shock, encephalopathy, diarrhoea, disseminated intravascular coagulation (DIC) and renal and hepatic failure in previously healthy infants. Severe hypoglycaemia has been repeatedly reported in association with HSES. However, the pathophysiology of the hypoglycaemia is not clear. We report on two infants (2 and 7 months old) with typical HSES, both of whom were presented with nonketotic hypoglycaemia. In the first case, plasma insulin was 23 pmol/l at the time of hypoglycaemia (0.1 mmol/l). In the second case, increased values for interleukin-6 (IL-6) (319 pg/ml) and IL-8 (1382 pg/ml) were found 24 hours after admission, whereas IL-1 and tumour necrosis factor-alpha (TNF-alpha) were not measurable. Alpha-1-antitrypsin was decreased (0.6 g/l). In hyperpyrexic, unconscious and shocked infants, HSES should be considered and hypoglycaemia should be specifically looked for. Hypoglycaemia is not caused by hyperinsulinism but may be secondary to the release of cytokines.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
2/3. Malignant insulinoma presenting with recurrent episodic loss of consciousness.A 57 year old male presented with episodic behavioural abnormalities and loss of consciousness for 2 years. His fasting blood glucose was 20 mg/dl and corresponding insulin level 119 uU/ml. His EEG showed intermittent rhythmic delta activity. Abdominal CT scan revealed an enhancing mass in the tail of the pancreas and secondaries in the liver. After distal pancreatectomy, resection of the left lobe of the liver and chemotherapy, the hypoglycaemic spells subsided. Histopathology revealed an islet cell tumour with metastases in the liver. Episodic neurobehavioural dysfunction should alert towards the possibility of hypoglycaemia.- - - - - - - - - - ranking = 0.11111111111111keywords = hypoglycaemia (Clic here for more details about this article) |
3/3. insulinoma presenting as alcoholic stupor.We report a case of prolonged loss of consciousness due to hypoglycaemia following ethanol abuse in a non-diabetic. The patient also reported symptoms compatible with hypoglycaemia following heavy manual work. Further investigations revealed a pancreatic insulinoma, which was successfully removed surgically. The patient remains asymptomatic 18 months later, despite occasional episodes of ethanol abuse. This case illustrates how heavy exercise and/or alcohol abuse can aggravate spontaneous hypoglycaemia.- - - - - - - - - - ranking = 0.33333333333333keywords = hypoglycaemia (Clic here for more details about this article) |